Artemis, it’s decision time…

Thanks to today’s X-rays and ultrasound, we have some answers. Sadly for Artemis, the answers are not good. Not good at all.

Artermis’ left kidney is quite small, only 2.8cm long. A normal cat kidney might be 3.5 to 4.5cm. Perhaps she was born with it small, perhaps it’s been damaged later. Kidneys do shrink with some chronic problems. But either way, it’s clearly dodgy.

The right kidney is bigger, but there’s a kidney stone. It’s only 1.5mm in diameter, but we’re talking about a cat not a human. That stone is currently blocking the urethra, and perhaps a back-up of urine is inflating that kidney. It’s possible the stone has only just moved there, which could explain the reversal of Artemis’ blood results over the past few days.

“I would have thought she wouldn’t have recovered as well as she did initially with that stone there,” Dr Emily Payne at Pet Vets told me this afternoon.

Now if this were simply a kidney stone, we’d just operate and remove it. “If it was just that one kidney, the prognosis wouldn’t be too bad,” Dr Payne said. But with the other kidney clearly not right? “The outlook isn’t that great.”

Since so many people now have a stake in Artemis’ future, I’ll present the options and ask for your advice.

There are less-invasive surgical techniques, which I’ll perhaps-inaccurately call “keyhole surgery”, that could remove that kidney stone. The operation would have to be done by the University of Sydney’s surgeons. The cost would be in the order of $3000. If in their pre-surgery investigations they decide that full surgery would be required instead, that’d be more like $4000 to $5000.

If we did some pre-surgery investigations — and the Uni has better imaging equipment and more experienced operators — that would probably cost under $1000, and would count towards any subsequent surgery costs.

There is no guarantee that surgery would succeed, of course. It may well be that both kidneys have been damaged beyond repair. That wouldn’t be known until the surgery had been done, the stone removed, and this process of determining kidney health done all over again.

Even with successful surgery, Artemis might well require a kidney transplant — and apart from the massive cost would they even recommend it in these circumstances? — or permanent dialysis-like fluid support, or more. And don’t forget that we haven’t even considered those lesions in her mouth — although my gut feeling is that with all this talk of kidney problems it’s less likely to be the dreaded mouth cancer.

Costs so far have been $109.10 for Pet Vets’ initial work, $558.85 for the emergency hospital visit, and around more $1300 at Pet Vets so far. That’s a total of just under $2000.

Donations so far total around $3500. In other words, they cover the costs so far, plus any pre-surgery investigations. They would not cover any surgery itself, nor any subsequent costs.

I’ve told Pet Vets that I’d discuss Artemis’ condition with you all overnight, and that I’d be in touch tomorrow with our decision on how to proceed. So how should we proceed?

Before you answer that, do remember that not all stories have a happy ending. Remember the sunk cost fallacy. And have you seen the news? There are bigger stories unfolding this week. I should also flag that some donations were from friends who insisted I should also take care of myself, given my need to move house.

So… what say you all?

I will be here to moderate comments and answer questions through the evening and until I decide I’ve run out of energy.

[Photo: Artemis at Pet Vets, 9 January 2011.]

66 Replies to “Artemis, it’s decision time…”

  1. @Alex: She’s 7 years old, so a mid-adult cat. That’s of course one of the factors that makes this a little harder to deal with. Another being that she’s currently sitting in her cage, chirpy as anything, showing no external signs of poor health.

    1. It does make it a harder decision for sure as typically she’d have many more good years left.

      I think it’s lovely that you (and others donating) want to spend what it takes to get her healthy, but the costs can get scary very quickly. My beloved burmese cat was fine last year, then went to the vet’s with stomach problems and cost ยฃ500, then ยฃ250… and was ‘cured’ then a few weeks later the issues returned with no end in sight, and my poor parents had to let him go. He was 14 though.

      With this case, Stephen makes a good point – if you can get a more conclusive diagnosis then things become clearer. Without that clear(er) diagnosis, and the high likelihood of serious vet bills that could spiral into the unknown, I’d personally have to take a more pragmatic, but sadder direction. ๐Ÿ™

  2. I say the more advanced imaging is worth it. Always.

    Cats have notoriously iffy kidneys. I’m guessing the result of us humans inbreeding them meticulously over the centuries. If, with all the more advanced non-invasive investigation, you can conclude Artemis can live a full, if limited in some way, life, I say do it. If not, you have to make the hardest of calls.

    We lost a cat last year about this time to a mysterious paralysis. We discovered her in a hedge unable to move. Several days of testing at the vet we use eliminated poison, bites, etc. Everything but a “might be cancer” lump near her spine.

    Given we saw no improvement over many days, we made the choice to euthanase. That may not be for you.

    I think I sound like I’m trying for an each-way bet here…

    Regardless, you have my number, etc., so always available to talk to.

  3. I wish I could HTFU and give a definitive answer.

    All I can do is offer another question to assist with the difficult decision: what would Artemis’ quality of life be in these scenarios?

    I know this will not help in any dramatic way.

  4. I feel terrible that you have to face this decision, which I did in April last year and also in July 2009. My kittehs are cremated, in little urns that I keep in my bedroom. I did not have the wherewithall for the vet bills, nor the support of public donations, however my siblings did help me immensly with paying some of the bills.

    I was with both MumuCat and Moochie as they were euthanised. I held them both through the entire process. It was very sad, but it was thier time. I’d rather see them go peacefully than in agony and pain.

    My thoughts are with you. I know how difficult this must be. But in your heart and gut you will come to the right decision.

    xx

  5. To be honest, and I don’t want to seem callous about this, under the circumstances of your own financial hardship, I would budget another $1000 at the most for poor Artemis, and if that proves unable to provide for her health, that it would be best to say goodbye and have her put down. If the prognosis was good for $3-$5,000 then I would be less fatalistic, but it seems even after that amount of money that yet chances are poor. At the end of the day she would be no better off but you would be in much more site straits.

    ๐Ÿ™ #internethugs

    All the best,
    Tom

  6. I have to say that agree with Tom’s points on financial situations

    I guess the other thing to think of would be how hard it would be on Artemis to have that sort of an operation. I imagine that sort of surgery would be hard enough to deal with in a human let alone a cat with already failing kidneys. If Artemis is not guaranteed quality of life after enduring all of that, it could be more cruel to continue.

    I do wish you all the best in whatever happens. Its a horrible position to be in.

  7. I hope you’ll forgive me if I don’t respond in detail to every comment. Rest assured, I’m reading everything, and thinking about it.

    People have asked, here and elsewhere, about Artermis’ potential quality of life after any surgery. That would of course depend on the remaining kidney function. Dr Payne tells me that total kidney function has to be all the way down to 25% of normal before there are serious health effects. Remember, us humans can survive quite happily on one kidney — hence kidney donors. Cats are no different.

    But Artemis already has reduced kidney function. How reduced, we don’t know. There’s still that spectrum of possibilities. At one end is removing a kidney stone and discovering the starboard kidney works just fine. Problem over. At the other end is the very real possibility that both kidneys are all but useless anyway, and it’s game over. In the middle is everything from a cat with chronic poor health and the need to closely monitor her diet, or a need to inject fluids subcutaneously every few days. We simply don’t know, and wouldn’t know until after any surgery itself and the recovery period, not just after some more imaging.

    Surgery has its own risks too, yes. Especially for an animal with poor kidney function. That’s why we haven’t even given her anaesthetic so we can take that biopsy to rule out cancer.

    If I may put some cards on the table, when I held her last Wednesday evening before we took her to the emergency ward, I knew I was holding a dying mammal. It’s not the first time I’ve done that, nor did every time involve a non-human. Has the entire week been borrowed time?

    Thank you all for your thoughts so far.

  8. It IS possible to negotiate with vets. They are service providers and altho my animals are like my children, I negotiate EVERY procedure, get a fixed price & then go ahead.

    I have a 16 year old cat that has cancer. My vet suggested $5,000 worth of chemo. Let’s be realistic, vets are a BUSINESS. I have made the decision to not treat her & allow the other cats time to say goodbye & also look after her. She will let me know when shes had enough.

    To suggest an operation & chemo for a 16 year old cat is ludicrous.

    Please, I urge you to ‘negotiate’ with the vets involved. You never know unless you ask.

    I feel for you mate, but it’s entirely your decision & nobody will judge you whatever the outcome.

    Tara ๐Ÿ™‚

  9. Growing up on a farm, a safe sanctuary of contemplation I find myself in quite often these days, you learn the value of life.

    Also, you learn that life is not forever.

    Sometimes its best to euthanise and remember Artemis for who she was. A friend for a time, but her time has passed.

    As, sadly, all our times will pass.

    And sadness will arrive no matter the choice made.

  10. Far be it from me to tell you what to do, so I am not going to do that. I will pose a few questions to you though and share an experience of my own.

    The 1st question is, can you afford the operation? If you can’t there’s not really much choice.

    What will Artemis’ quality of life be like after the operation? If she’s going to require regular dialysis? Will she be able to cope with that?

    Are you just prolonging the inevitable?

    They all seem like really arsey questions, but I think you need to think about the answers to them.

    Having said all that my preference would be to do everything you can, I know we did in the past.. heres my story.

    We used to have a German Sheppard named Tiger. He was a brilliant beautiful dog. Many years ago he was diagnosed with degenerative myelopathy, which is basically MS for dogs.

    Luckily for him, and us, there is’nt really any pain associated with the condition, they just loose motor function and control of their body, particularly the back half.

    He’d walk, or even run, around and then all of a sudden his back half would just collapse. We’d just help him up again and he’d go back to whatever he was doing, which was usually chasing the other dogs. This upset him occasionally, but most of the time he was still a very happy dog.

    The other problem with his condition was that he lost bowel control. He used to crap himself a lot. This he didn’t like, probably less than we did. I kinda feel he used to find it embarrassing. We just used to clean up after him and try to make as little fuss about it as possible so as not to upset him. I mean its not like he was meaning to do it.

    We did this for about 7 years I reckon before he’d gotten so bad as he was falling over more than he was able to run and he was no longer happy all the time like he once was.

    We took the decision to get him put down. I was a tough decision to make, and to this day (it was about 2.5 years ago now) I still sometimes wonder if we did the right thing or not, but we did.

    My point of the story is that for all those years we had to look after him he was still a GREAT DOG and I am so glad we did it. I think most people wouldn’t have been up to put up with it like we did, but again I am glad we did and I’d certainly do it all over again.

    A sick pet can still love you and you can definitely still love them. My advice is do all you can, your wallet will be the only thing that regrets it, and hell it’s only money.

    The other thing I will say is be clear from the start at what point is too much for Artemis and you to bear. You will know when the time is right, but if you’re like me the little niggle that your doing the right thing will remain.

    Apologies if this reply is a little longer that what you’re expecting, but.. well you know.

    Regards
    Ross

  11. The doctor’s prognosis of, โ€œThe outlook isnโ€™t that great,โ€ the general assessment of the condition of each kidney described and the cascading ifs of success and quality of life that litter the path of organ transplant means that I would be – reluctantly – opting for euthanasia. Hugs.

    All the best.
    Sylvano

  12. its very tough.

    2004 my 4 year old tabby did a kamikaze jump off a 4 storey building and broke her leg. despite quarantine the leg break somehow caused an infection to her chest and she developed a large abcess. the costs kept mounting incrementally for scans and surgery and totaled at $3000. id did not have insurance, had to dip into savings. she was right as rain for 6 more years of love and hugs – totally worth it.

    2010 same tabby mauled by a dog, her internal organs shredded and stanmore medical centre had to piece her insides back together “like patchwork”. cost of $6000 which insurance wouldn’t cover all of. i negotiated with stanmore to pay the outstanding amount on a payment plan weekly over a year – i was the first ever customer to do this but they said all vets have that ability – you should look into it if you don’t have enough savings to cover the costs. she recovered nicely but passed away anyway within 10 months of a brain tumour.

    in summary – paying for the procedure does not guarantee a long time with your animal afterwards. but artemis is a family member who – based on survival chance – should get an opportunity to have the best medical treatment. i recommend getting the full treatment, demanding a payment plan if you cant afford it all and above all getting pet insurance.

  13. I’d support whatever well-being choice you are making for Artemis. Leave money aside from the decision. Many will help fill the funding gap quickly if the choice is to operate so just make the right choice for you both and tell people and it will work out financially I’m sure.

  14. When we lost Felix on Friday 13 August last year, it was all over very quickly, before we had an opportunity to do something about it. He was young like Artemis (well, less than half her age).

    Would we have spent the kind of money you mention? Definitely. If the prognosis were less than optimistic? This is where it becomes difficult.

    My recommendation would be to invest in the pre-surgery investigation (particularly as it’ll count towards any further procedures) and possibly haggle (great idea, Tara). Depending on the result, the cost, and the likely quality of life for Artemis, that should help you with the tough decision.

    My thoughts and my sympathy are with you, and with Artemis.

  15. I have to agree with Nick on this. We had 4 months of ‘borrowed time’ with Moochie (breast cancer spread to lungs) so we knew she would die. We treasured that time. We also knew when it was ‘that time’.

    But with MumuCat it was like Artemis, sudden unknown issues causing her body to shut down. Two weeks of many nights at the vet until I had to make the decision. It’s a tough one. If only Artemis could speak. Would she want to be at home? If she’s chirpy perhaps you could have her at home for a while and not rush things.

    Indeed sadly you will have to put your own needs ahead of hers.

  16. I have prepared myself for this since the last post.

    Stil, you have tried your very best to keep her. There is another cat, Apollo, which I am also concerned. He sees his family disappear one by one.

    Take care of the of the healthy ones including yourself.

  17. If it were my decision I would start with investigation (the second option) and make a judgement either for the surgery or straight to a transplant. If the operation didn’t work I would rather take some time to say goodbye than endlessly inflict more treatment. I used to think we were kinder to our pets in being able to let them go with dignity and without suffering.

    In the end i find you have to do what feels right to you. My sympathy to you and your other cat, and I hope for a happy ending.

  18. I’m going to sit on the “sounds like a heartless bastard” side of the fence, and say that letting a pet dig you into a serious financial hole is not a good idea.

    As a pet owner, you do sign up for responsibility to the pet, but at some number of thousands of dollars the actions required by that responsibility end up having to be “make sure the end is dignified”.

    Sometimes it _is_ the right decision. Often the decision was clearly going to be made many thousands of dollars before it was admitted to. If you can afford multi thousand dollar vet bills, of course you do it if there’s a chance it’ll help. If you can’t afford them, you can’t afford them.

    I held this puppy while the vet injected the green goo a year or so back:
    http://www.flickr.com/photos/bigiain/3706552348/
    it was the right thing to do.

    Sometimes all the options are bad. You’ve still got to pick one.

    big

  19. My thoughts have been well expressed by Nick and Susan, so I won’t repeat them just for something to say. I also think you need to take care of yourself with the upcoming move & all.

  20. What I can guarantee, is whatever decision you make Artemis will understand. You will feel guilty no matter how many experts and friends say you did the right thing. Obviously cost is an issue. My vet (and friends), as I was a long term trusted owner, allowed a payment plan when my cat needed expensive treatments. Can the Uni offer something of the sort? Also, would they take other types of payment? You’re a media type person with an audience, they’re a business that appreciates attention.

    I’m probably not saying anything you’ve not considered, but for me, sometimes it takes others saying it to make it real.

    So our household says you should take a shot at surgery and try and get the stone out, cos she can live on one kidney since it seems the stone is most likely causing her reversal of form. She’s got life in her, she’s been fighting. Money will come.

  21. When my girl died a year ago suddenly a vet said to me that I could have spent three, four thousand dollars (had I got her to the vet in time) and had the same outcome. Ask me today and I’d say, there is no dollar figure I could put on having her here.

    But realistically, the decision has to be what is best for her, quality of life wise. I would def look into more diagnostics to determine what would be best; the vet should be able to give you detailed information on what you both will be looking at post operation(s) eg ongoing treatment, meds, food requirements etc. Is it likely she will be her old self again?

    I feel for you greatly. It’s the hardest decision we ever have to make, because we feel like we can’t ever know what is right. I always think you can tell by a cats eyes whether they are in it for the long fight. Something goes from them (eyes) when they are ready for the next world.

    My thoughts are with you. Keeping fingers crossed!

  22. Thank you for giving us the opportunity to speak. As an animal sensitive since birth, I can tell you that Artemis is family and she loves you and she doesnt want her life cut short. We run an animal sanctuary almost entirely on natural therapies – very, very , very successfully. We have been surprising the vets lately — shocking them in fact. One dog was given three days when the vet discovered a huge tennis ball size tumour in her gut. She is thriving today, thanks to natural therapies. When an animal has a will to live, it is my experience, that when providing the right healing environment, the animal will live. And live healthfully.

    My rule of thumb is that I never give up on an animal in need while there are options to explore and alternative therapies are there to explore. I would suggest you take Artemis to a holistic vet for a second opinion. I personally work with a homeopath for my kidney cats and they live on and on — until it really is their time at a ripe old age. This also would be a much cheaper option and it is certainly a compassionate one.

    If the stone cannot be dissolved and needs to be removed, then surgery for that, followed by homoeopathy to repair the kidneys. Anything is possible.

    Also — no dried food. This creates more kidney problems than most people will ever realise.

    She wants a chance at life. Please consider looking at alternatives that might help her live a quality of life, that the vets find unexpected.

    Blessings
    Billie

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